Acceptability and effectiveness of digital prehabilitation and personalised support for patients with cancer in the UK National Health Service.
Authors: Venetia Wynter-Blyth, Laura Halliday, Alex King, Louise Smith, Lou Wasilewski, Amina Drir, Laura Campbell-Lee, Dana Frank, Christopher Scrase, Krishna Moorthy
Journal: Journal of Clinical Oncology (2023)

1587 Background: Prehabilitation is associated with increased tolerance to oncology treatments, reduced post-operative complications and hospitalisations. Most prehabilitation programmes are delivered in hospitals or community centres. However, large-scale implementation is limited by problems of access, workforce demands, travel costs and sustainability. Digital technology presents an opportunity to address concerns and broaden access. The aim of this study was to explore the feasibility, acceptability and effectiveness of a digital prehabilitation service. Methods: Since January 2022 a digital coaching model of physical, nutritional and psychological optimisation was implemented across a sample of NHS hospitals, provided by Onkohealth Ltd. Patients were onboarded onto the 12-week programme through a native app or, for those without access to smart technology, a web-based pathway. Baseline health metrics were collected through a combination of validated survey tools and wearable technology. Patients were matched to a personal health coach for ongoing guidance and support. The intervention combined digital behaviour change techniques with remote monitoring and real-time targeted support from their coach when the need is triggered. Self-reported physical activity (PA) was recorded and calculated as METS min week -1 . Psychological wellbeing outcomes and e-PROMs included self-efficacy, quality of life [EQ5D5L Health Utility (EQ-HU)] and a visual analogue scale (EQ-VAS)] before and after completion of the 12-week programme. Results: 303 patients were referred to the service. 228 (75.2%) accepted and started the programme. 167 (74%) followed an app-based programme. 24 patients (12.2%) discontinued. 103 patients, on different oncological pathways, completed the 12-week programme. 30 completed a median of 4 weeks pre-operatively. 12 started post-operatively. 61 received chemotherapy (neoadjuvant: 17; adjuvant: 23 and palliative: 21). A complete pre-post data set was available for 47 patients. There were significant improvements for all study metrics: PA mean difference 323 METS min week -1 (95% CI 45 to 600), p = 0.024; distress mean difference -1.2 (95% CI -2.3 to -0.1), p = 0.025; anxiety mean difference -1.5 (95% CI -2.7 to -0.3), p = 0.018; depression mean difference -1.3 (95% CI -2.5 to -0.1), p = 0.04; EQ-HU median 0.71 (IQR 0.57-0.84) to median 0.77 (IQR 0.65-0.84), p = 0.041; EQ-VAS mean difference 15.4 (95% CI 5.7 to 25.0), p = 0.003; self efficacy mean difference 3.2 (95% CI 0.6 to 5.7), p = 0.015. Conclusions: This is the first study on the implementation and effectiveness of a digital model of prehabilitation and coaching for cancer patients. Patients respond positively in nearly all dimensions of physical and psychological health despite being on oncological treatments, with a significant improvement in self-efficacy, EQ-HU and EQ-VAS.